Tacrolimus in non-Asian patients with SLE: a real-life experience from three European centres

Abstract

ObjectivesTo analyse the real-life practice on the use of Tacrolimus (TAC) in patients with systemic lupus erythematosus (SLE) from three European SLE referral centres.MethodsAdult patients with SLE regularly followed at three European referral centres were included. Demographics, cumulative organ involvement, treatment history, Systemic Lupus Disease Activity Index (SLEDAI), laboratory features and physician’s judgement were collected at baseline and at 3–6–12 months after starting TAC.Results29 patients were included (89% female, mean age 38±9 years). Ethnicity was predominantly Caucasian (82%), Black African (11%), Hispanic (3.5%) and Caribbean (3.5%). The main indications for TAC prescription were renal involvement (82.7%), arthritis (10.3%), cutaneous manifestations (6.8%), haematological manifestations (6.8%), serositis (3.4%). At 3 months, there was a clinical improvement in 21 patients (72.4%) and 9 of these experienced a complete resolution of symptoms (31%). This corresponds to: (1) a significant decrease in the mean SLEDAI; (2) a significant decrease in the mean 24 hours proteinuria; a significant increase in C3 and stable creatinine values. At 6 months (n=25), the physician declared an improvement in 19 patients (76%) and a complete resolution of symptoms in 9 (36%). The same trend was observed at 12 months of follow-up. TAC was discontinued in nine pts (31%); reasons for discontinuation were inefficacy (13.8%), drug intolerance (10%) and disease remission (6.9%).ConclusionsDespite the limitation due to the small number of patients and the uncontrolled nature of the study, these data show that TAC can be considered a valid therapeutic option in patients with SLE, especially for renal involvement.

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“…156 Tacrolimus, a calcineurin inhibitor used as a single agent or in combination with MMF in SLE, has been associated with a relatively low incidence of severe infections in various reports, although data are scarce. 156,176,177 A comparison between SLE patients on sGC and tacrolimus vD 1 4 5 X Xs those on sGC and CYC showed a similar incidence rate of herpes zoster and varicella between the D 1 4 6 X X2 groups. 178 Belimumab, a B lymphocyte stimulator D 1 4 7 X Xinhibitor, is currently the only biologic approved for use in SLE.…”

Tacrolimus reduces atherosclerotic plaque formation in ApoE-/- mice by inhibiting NLRP3 inflammatory corpuscles

“…Tacrolimus, also known as FK506, is a potent immunosuppressor, which, as a first-line drug in liver, kidney and heart transplantation, has come into the market in Japan and the United States in recent years (15). At the same time, it also plays a positive role in the treatment of such autoimmune diseases as atopic dermatitis, systemic lupus erythematosus and autoimmune eye diseases (16)(17)(18). A large number of clinical studies have proved that tacrolimus can significantly reduce the incidence of early initial poor function (IPF), primary nonfunction (PNF) and delayed nonfunction (DNF) caused by ischemia-reperfusion injury after transplantation (19)(20)(21), and ischemia-reperfusion injury is essentially a non-specific inflammatory response, indicating that tacrolimus has an anti-inflammatory property.…”

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“…Besides, recent research has demonstrated that the combination of MMF and tacrolimus (TAC) at the half dose is more therapeutic than monotherapy in inhibiting MC proliferation in vitro and in vivo ( 130 ). TAC is a valid treatment option for SLE patients with renal involvement ( 131 ). TAC targets the Smad2 signaling pathway, and MMF targets the p38 signaling pathway, both of which could inhibit MC proliferation ( 130 ).…”